My career objective is to develop an independent research program focusing on the safe and effective use of medications in rural communities. More than 400,000 harmful medication errors occur each year. While significant advances have been made in large hospitals, little research has been conducted in the nation's 1,300 critical access hospitals where differences in personnel, infrastructure, and care delivery processes make the generalizeability of findings observed in large urban facilities difficult. The lOM has recognized the need for comparative effectiveness data, recommending that future research should focus on how to select an individual application, such as CPOE, bar coding, and smart pumps. The purpose of the proposed research is to compare the effectiveness of two medication use technologies used by critical access hospitals - bedside bar-code administration and telepharmacy. This proposal directly addresses the lOM's recommendation and four of the seven areas of research interest listed by AHRQ. To complete this research, a career development plan has been developed that combines didactic coursework, mentoring, and applied research. New analytic techniques needed to address limitations of observational study designs - including propensity scoring, instrumental variables, and hierarchical modeling - will be learned. Practice Based Evidence for Clinical Practice Improvement (PBE-CPl) is a methodology that incorporates natural variation from routine clinical practice to determine what works, for whom, when, and at what cost. This promising study design will be incorporated into the research program. UNMC provides an excellent training and research environment for individuals interested in health services research. Senior investigators in the College of Public Health including the Department of Biostatistics, and the College of Pharmacy will provide mentoring throughout the program. The hands-on experience and formal training described in this research and mentoring plan will provide me with the specialized expertise necessary to conduct an independent line of research. RELEVANCE (See instructions): The results of the proposed research will provide small hospitals with the information they need to choose the most cost-effective technology to reduce medication errors in their facilities. This program will improve medication safety, reduce harmful medication errors, and improve the quality and efficiency of healthcare for those living in, and traveling through, rural America.